Improving cancer survival rates through confidence in radiotherapy

Cancer statistics for the UK make sobering reading; one in two people born after 1960 will be diagnosed with some form of cancer during their lifetime and there are currently approximately 330,000 new diagnoses every year, a number which grows by around 2% per annum. We will all be affected by cancer in some way at some point in our lives, and when it happens we need the reassurance that we will have access to the best treatment possible. Despite significant improvements that have been made in treating cancer over the last 40 years, the UK survival rate continues to lag behind that in countries of similar wealth.

The UK has a deserved reputation for creativity and excellence in designing and developing new interventions with the potential to deliver significant improvements in outcomes. However, apart from a few leading centres, we are slower than other countries to adopt new innovations, even where they are clearly cost-effective and/ or were developed within our own health system. One of the critical enablers for rapid and widespread adoption of new innovations is ensuring that their performance, safety and effectiveness can be measured and optimised in what is necessarily a conservative community.

NPL has played a key role in supporting the UK medical physics community from the beginning of the twentieth century. This was initially through the design, construction and calibration of specialised equipment alongside the development of world leading codes of practice. These professional guidelines are drafted in collaboration with the Institute of Physics and Engineering in Medicine, to ensure rigorous and consistent dissemination of dose quantification into the clinics. A recent review of data collectedby NPL over the last 20 years has shown this work has assisted in considerably reducing the variability of the dose delivered across the nation. In more recent times, ground-breaking measurement research has been undertaken to support innovative treatments which require novel approaches to measurement to ensure continued consistency of the dose delivered to the patient.

In 2012, the UK government invested £23 million with the aim of significantly increasing the number of patients benefitting from access to intensity modulated radiotherapy (IMRT), a more advanced and targeted form of treatment. In order for this to be achieved, it was necessary for the treatment to be delivered using a faster and more complex rotational delivery system (RIMRT). As a much more targeted and advanced form of radiotherapy, it was essential to audit delivery systems with differing capabilities across the UK, and assess whether each had been optimised uniformly before implementing the technique. This provided confidence that regardless where a patient received treatment, it would be of the same standard of excellence. Around two thirds of all UK radiotherapy centres were included, demonstrating an impressive 97% pass rate with a comparative exercise conducted in the USA achieving a 90% pass rate.

NPL plays a unique role in helping to ensure that new innovations in treatment provide the better patient outcomes they promise

NHS England funding has since enabled NPL, in partnership with the national radiotherapy trials group, to play a key role in ensuring the safe and optimised uptake of new radiotherapy techniques such as stereotactic ablative body radiotherapy (SABR) for non-small cell lung cancer and stereotactic cranial radiosurgery (SRS) – a specialist form of radiotherapy that can be used to treat patients with conditions such as benign and malignant brain tumours. Both of these national audits have highlighted and resolved issues with inconsistencies in implementation that have resulted in significantly reduced variation in the dose delivered to the patient.

NPL continues to offer verification services to centres within the UK and abroad, with several countries now basing their audit techniques and protocols on those developed by NPL and its collaborators. We are currently leading an ‘audit of auditors’ project, supplying international clinical trial audit groups with a set of virtual audit measurements containing known errors, which are then analysed and interpreted by the individual groups and their analysis reported back for assessment. This will allow centres from multiple countries to be included in international clinical trials, which is of particular importance for more rare cancers and/or new techniques such as proton beam therapy (PBT).

The UK has been successfully treating rare eye cancers with proton beam therapy at the Clatterbridge Cancer Centre for many years, yet we have been slower to adopt new high-energy proton beam therapy; higher energies are needed to penetrate further into the body. However cutting-edge PBT technology is now being adopted across both NHS and private centres in the UK. Adopting it later than other countries means we have more work to do in ensuring its best use here. To help meet this challenge, NPL has established a physics research consortium with members from NHS centres and academia, and is running regular workshops aimed at promoting research collaborations within the UK. NPL is also contributing to a code of practice that will be the world’s first written specifically for PBT based on a proton beam calibration. This will allow centres to calibrate their beams more accurately, so they know with more certainty how much radiation dose they are giving each patient, reducing side effects and increasing treatment effectiveness.

With our well-established expertise in underpinning and improving the accuracy of cancer therapy delivery, NPL plays a unique role in helping to ensure that new innovations in treatment provide the better patient outcomes that they promise, in order to help realise the NHS’s target to deliver consistent, ‘world-class’ cancer care by 2020.

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